Orthopedic Center's Cast Care & Maintenance

A cast holds a broken bone in place as it heals. Casts also help to prevent or decrease muscle contractions, are helpful at providing immobilization, especially after surgery, and therefore can help decrease pain. Casts immobilize the joints above and below that area that is to be straight and without motion. For example, a child with a forearm fracture will have a long arm cast to immobilize the wrist and elbow joints.

What are casts made of?

The outside, or hard part of the cast, is made from two different kinds of materials: plaster and fiberglass. Cotton and other synthetic materials are used to line the inside of the cast to make it soft and provide padding around bony areas, such as the wrist or elbow. They also pad nerves and blood vessels from pressure (see image on right for examples of padding materials: (l) gortex, (r) cotton).

Special waterproof cast liners may be used under a fiberglass cast, allowing the child to get the cast wet. These waterproof liners can only be used when the swelling from the injury has decreased, usually a week or two after fracture. They can’t be used after surgery or when pins are used due to a risk of infection.

Plaster casts:

Fiberglass:

• Lower cost
• Molding ability
• Comes in one color: white

• More durable
• Lightweight
• Comes in a variety of colors, patterns, and designs

What are the different types of casts?

Upper extremity

Short Arm Cast

• Applied below the elbow to the hand
• Used for forearm and wrist fractures
• Also used to hold the forearm or wrist muscles and tendons in place after surgery
• The upper casts (blue) are used for thumb injuries
• The lower casts (pink) are used for finger fractures

Long arm cast

• Applied from the upper arm to the hand
• Used for upper arm, elbow, or forearm fractures
• Also used to hold the arm or elbow muscles and tendons in place after
surgery

Arm cylinder cast (not shown)

• Applied from the upper arm to the wrist
• Also used to hold the elbow muscles and tendons in place after a dislocation or
surgery

Shoulder spica cast (not shown)

• Applied around the trunk of the body to the shoulder, arm, and hand
• Used for shoulder dislocations, or after surgery on the shoulder area

Types of casts for the lower extremity

Short leg cast

• Applied to the area below the knee down to the foot
• Used for lower leg fractures, severe ankle sprains/strains, or fractures
• Also used to hold the leg or foot muscles and tendons in place after surgery to allow
for healing
• The fracture needs to be stable enough for your child to be able to walk on it safely
• Because they can kick off a short leg cast, children under the age of 5 will usually
require a long leg cast

Leg cylinder cast/long leg cast

• Applied from the upper thigh to the ankle
• Used for knee or lower leg fractures, knee dislocations, or after surgery on the leg or
knee area
• Usually the knee is bent, as shown, to prevent your child from walking on it

Unilateral hip spica cast (Also known as single hip spica)

• Applied from the chest to the foot on one leg
• Used for thigh fractures
• Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing

One and one-half spica cast

• Applied from the chest to the foot on one leg, and to the knee on the other leg. A bar is placed between both legs to
keep the hips and legs immobilized
• Used for thigh fractures
• Also used to hold the hip or thigh muscles and tendons in place after surgery to allow healing

Bilateral long leg hip spica cast (also known as double hip spica)

• Applied from the chest to the feet. A bar is placed between both legs to keep the hips and legs immobilized
• Used for pelvis, hip, or thigh fractures
• Also used to hold the hip or thigh muscles and tendons in place after surgery to allow for healing
• Applied from the chest to the thighs or knees
• Used to hold the hip muscles and tendons in place after surgery to allow healing

Abduction boot cast

• Applied from upper thighs to the feet. A bar is placed between both legs to keep the
legs and hips immobilized
• Used to hold the hip muscles and tendons in place after surgery to allow time for
healing

Clubfoot cast

• Used to treat clubfoot
• Applied from upper thighs to toes
• Usually changed every 5-7 days

Application and removal of your cast

Applying a cast

There is no pain associated with the application of a cast. You and your child will be brought into the cast room by one of our twelve cast technicians. The cast application will vary depending upon what type of cast your child will be receiving. Your cast technician will go over the specific details with you.

A stockinette will be placed against the skin. This will become the cuff around the edges of the cast and will help to keep the padding intact. A cotton padding will be applied followed by the fiberglass or plaster cast material. Initially the cast will be white in color, this is what the structure of the cast is made of, then the last layer of material will be the color of choice. We have fifteen colors and patterns to choose from.

Your child will feel warmth from the chemical reaction as the fiberglass sets up. It will not burn, but should feel warm –like a bath. This reaction will last about 10 minutes. It will take less than 5-10 minutes for the cast to completely set.

Can my child get a water-proof cast?

You may speak with the doctor or nurse about this option during your appointment. If your child was seen in the Emergency Department and the doctor in the ED told you that your child is eligible for a water-proof cast, your child must wait at least 5-7 days before she can switch to a water-proof cast due to concerns of swelling. There is an extra cost for a waterproof cast as most insurance companies do not cover the cost for a water-proof cast. Another choice is a special waterproof sleeve that can be purchased.

Moving around while in a cast

Assistive devices for children with casts include:

• Crutches
• Walkers
• Wagons
• Wheelchairs
• Reclining wheelchairs

Removing a cast

Cast removal can be a scary thing for children. The cast technician will use an oscillating saw to remove the cast. An oscillating saw does not spin, it rapidly vibrates back and forth. The cast saw does make a lot noise. Some children are afraid of this initially, but once we start to cut through the cast material, they begin to laugh due to the vibration. It is very important to tell your cast technician if your child has picked out some of padding, or placed anything inside the cast.

What should I do if my child has gotten his cast wet?

If your child’s cast has gotten wet, please contact us immediately at 617-355-6021. Wet casts can lead to complications and need immediate attention. A nurse will decide if your child needs to be seen that day, or the next. In most cases your child will need to be seen that day. If this occurs after normal business hours please contact the orthopedic physician on-call through the page operator at 617-355-6000. Your child may need to be seen in the Emergency Department to have the cast changed. Please note the above information does not apply to waterproof casts.

Caring for your cast

Once your child has been fitted with a cast there are important guidelines to follow. Our cast technicians will go over these instructions with your and your child.

• Keep the cast clean and dry. The best way to keep a cast dry when bathing is to
put two bags over the cast. Place a bag on the cast, then apply a towel around the
top of the cast with tape, followed by the second bag. This does not waterproof the
cast, but will help to protect from splashing. If the cast does get splashed on, you
can use a hairdryer on cool or low to dry it. If the cast gets very wet you will need to
have the cast changed within 24 hours.
• Check for cracks or breaks in the cast.
• Rough edges can be padded to protect the skin from scratches.
• Do not scratch the skin under the cast by inserting objects or fingers inside the cast.
• Prevent small toys or objects from being put inside the cast.
• Avoid sand, dirt or mulch. Loose particles may work their way into the cast.
• You can use a hair dryer placed on a cool setting to blow air under the cast and cool down hot, itchy skin.
Never blow warm or hot air into the cast.
• Do not put powders or lotions inside the cast.
• Cover the cast while your child is eating to prevent food spills and crumbs from entering the cast.
• Elevate the cast above heart level to decrease swelling.
• Encourage your child to move their fingers or toes to promote circulation.
• Do not use the abduction bar on the cast to lift or carry the child.

Older children with body casts may need to use a bedpan or urinal in order to go to the bathroom. Tips to keep body casts clean and dry and prevent skin irritation around the genital area include:

• Use a diaper or sanitary napkin around the genital area to prevent leakage or splashing of urine
• Place toilet paper inside the bedpan to prevent urine from splashing onto the cast or bed.
• Keep the genital area as clean and dry as possible to prevent skin irritation.

When to call your child's doctor

Contact your child's doctor or health care provider if your child develops one or more of the following symptoms

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